4. ANATOMY
• LINEA ASPERA -
• ROUGH CREST ON THE POSTERIOR ASPECT OF MIDDLE ONE
THIRD OF FEMUR
• SERVES AS ATTACHMENT FOR MUSCLES AND FASCIA’
• ACTS AS A COMPRESSIVE STRUT TO ACCOMMODATE THE
ANTERIOR BOW TO FEMUR
8. EPIDEMIOLOGY
• 1 FEMUR FRACTURE FOR EVERY 10,000
• BIMODAL DISTRIBUTION –PEAKS AT 25 AND
65YRS
• SEEN IN MALES AGED 15 TO 24 YEARS
• SEEN IN ELDERLY FEMALES AGED 75 YEARS
9. MECHANISM OF INJURY
• IN YOUNG INDIVIDUALS DUE TO HIGH ENERYGY TRAUMA SUCH AS
MVA OR FALL FROM HEIGHT
• IN ELDERLY A SIMPLE FALL
10. ASSOCIATED FRACTURES
• OFTEN ASSOCIATED WITH IPSILATERAL FEMUR
NECK FRACTURE IN 2.6% INDIVIDUALS .
• MISSED 19-31% OF THE TIME
31. CASE
• A 49-year-old man with a history of prostate cancer metastatic
to bone suffered a
pathological fracture to the left femur while hospitalized .
Eighteen hours after the
fracture, he developed hypoxemia and hypotension followed by
confusion and a
petechial rash in the left axilla. Chest X-ray obtained after
intubation demonstrated
new diffuse bilateral patchy infiltrates .
32. FAT EMBOLISM
• A SYNDROME CAUSED BY INFLAMMATORY RESPONSE TO EMBOLIZED
FAT GLOBULES
• CHARCATERIZED BY
• HYPOXIA
• DEPRESSION – CNS
• PULMONARY EDEMA
• PETECHIAL RASH
34. PATHOPHYSIOLOGY
• MECHANICAL THEORY – EMBOLISM CAUSED BY BONE MARROW FAT
RELEASED INTO VENOUS SYSTEM
• METABOLIC THEORY – STRESS FROM TRAUMA CAUSES CHANGES IN
CHYLOMICRONS WHICH RESULT IN FORMATION OF FAT EMBOLI